Treatment for Chronic Kidney Disease

Some types of kidney disease can be treated. But for most people with chronic kidney disease (CKD), there is no cure. The overall goal of CKD treatment is to prevent or slow the progression of kidney damage, treat the symptoms, and reduce and manage complications.^1,2

Treating CKD depends on many things, including the cause of kidney disease, the stage of kidney disease, and any other health issues (comorbidities). CKD treatment involves managing and preventing health problems that can further damage your kidneys, such as:^1,2

• Diabetes
• High blood pressure
• High cholesterol
• Heart disease

Treating diabetes

Diabetes is the leading cause of CKD. Treatment for diabetes depends on whether you have type 1 or type 2 diabetes.²

If you have type 1 diabetes, your doctor will prescribe insulin shots to help replace the insulin that your body does not make. If you have type 2 diabetes, several types of medicines can help lower your blood sugar while reducing kidney damage:^2-8

• Sodium-glucose cotransporter-2 (SGLT2) inhibitors –  allow the kidneys to excrete more sugar in the urine. This helps reduce blood sugar levels in people with T2D. They also help slow down kidney damage and preserve kidney function. Dapagliflozin (Farxiga^®) is an SGLT2 inhibitor approved for some people with CKD.
• Non-steroidal mineralocorticoid receptor antagonists (MRAs) – block overactive mineralocorticoid receptors that can lead to inflammation and scarring in the kidneys, heart, and blood vessels. MRAs help slow down the progression of kidney damage.  As of early 2024, finerenone (Kerendia®) is the only MRA approved to treat CKD in people with T2D.

If you have diabetes, work with your doctor and a dietitian to control your blood sugar.^1,2

Treating high blood pressure

High blood pressure is the second leading cause of CKD. High blood pressure places a lot of stress on the kidneys. Also, kidney disease can raise your blood pressure.^1,2

Your doctor may prescribe specific medicines to help reduce this added stress. Blood pressure medicines include:^1,2

• Angiotensin-converting enzyme (ACE) inhibitors – reduce blood pressure by blocking hormones that can tighten blood vessels, especially those in the kidneys, and lead to high blood pressure.
• Angiotensin receptor blockers (ARBs) – lower blood pressure by widening blood vessels. This makes it easier for kidneys to do their job.
• Beta-blockers –block adrenaline, a hormone that causes your heart rate and blood pressure to rise.
• Diuretics (water pills) – help you pee more. By peeing more, you are helping your kidneys flush out extra salt and waste in your blood.

Some blood pressure medicines can make kidney problems worse, while others can be good for the kidneys. Talk to your doctor about which ones are right for you.^1,2,8

Treating high cholesterol

High cholesterol can clog your arteries and make it harder for blood to get to your kidneys. High cholesterol can worsen kidney function. It can even lead to kidney failure and heart disease over time.^1,2

Statins are medicines that help lower cholesterol. Make an appointment with your doctor to check your cholesterol levels.²

Treating heart disease

Heart disease is another health issue that people with kidney disease may live with. Damaged kidneys place stress on other organs of the body, including the heart.²

If you have been diagnosed with heart disease, you may be prescribed many of the same medicines used to treat high blood pressure. These include ACE inhibitors, ARBs, beta-blockers, SGLT2 inhibitors, and diuretics.²

Complications of chronic kidney disease

CKD can create other problems in the body that often require treatment. These are called complications. They may include:^1,2

• Swelling
• Gout (painful joint swelling)
• Anemia (a low blood count)
• Metabolic acidosis (too much acid buildup in the blood and body)
• Weak bones
• Too much potassium (which can stop the heart from beating

CKD treatment involves trying to reduce these complications, usually through a combination of medicines and lifestyle changes.^1,2

Swelling

Swelling is a common side effect of kidney disease. This happens because the kidneys are not able to pee out all the extra water in the body. Diuretics can help get rid of excess water.¹

Gout

Gout occurs because of a buildup of uric acid in the body. Having kidney disease puts you at increased risk of developing gout. The symptoms of gout include:^8,9

• Swelling
• Tenderness
• Redness
• Stiffness

These symptoms usually take place in the joints of the hands, feet, and knees. They can be very painful. Certain medicines such as colchicine and cortisone may be used to treat gout.⁹

Making healthy changes to your diet is another way to treat gout. Doctors recommend that you:⁹

• Eat less meat
• Eat fewer high-purine foods – organ meats, alcohol, and processed foods with high-fructose corn syrup
• Eat more fruits and vegetables
• Drink plenty of water

Anemia

Anemia is when your body does not make enough red blood cells. This leads to symptoms such as fatigue and weakness.¹

Healthy kidneys make a hormone called erythropoietin, which tells the body to make red blood cells. But when your kidneys are damaged, they cannot make enough of this hormone. Also, people who have CKD cannot absorb enough iron from their diet. This also leads to low iron levels in the blood.²

Treatments for anemia in people with CKD include:^1,10

• Iron supplements – help the body make red blood cells
• Erythropoiesis-stimulating agents (ESAs) – trigger blood cell formation with supplements of the hormone erythropoietin
• Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) – trigger cells to make more erythropoietin. As of 2024, daprodustat (Jesduvroq^®) is the only HIF-PHI approved to treat anemia in people with CKD. It is meant for people who have received dialysis for at least 4 months.

Metabolic acidosis

Metabolic acidosis is the buildup of acid in your body. With low-functioning kidneys, the acid in your blood is not being filtered out. Treating metabolic acidosis consists of taking a sodium bicarbonate (which is essentially baking soda) supplement, which helps balance the acid levels in your blood.²

Osteodystrophy

Kidney disease increases the chance of developing osteodystrophy. This condition happens when you have abnormal changes to your bones as a result of kidney disease. It can lead to soft, brittle bones that can easily break or fracture.^1,2

In some people with CKD, osteodystrophy is caused by too much phosphorus in the blood. Taking a phosphate binder medicine can help.^1,2

In other people, calcium and vitamin D deficiencies lead to bone problems. Calcium and vitamin D supplements may help balance calcium and vitamin D levels in your body. Before taking any supplements, talk with your doctor about what they recommend.^1,2

Too much potassium

When your kidneys are damaged, potassium builds up in your body. Too much potassium can cause abnormal heart rhythm, make the heart stop beating, and even lead to sudden death. If your potassium is high, your doctor may want you to make changes in your diet. You may also need medicines called potassium binders to lower your potassium levels.¹¹

Lifestyle changes to slow kidney damage

There are certain lifestyle changes you can make to slow the progression of kidney damage. Changing your diet can reduce the amount of work your kidneys have to do. A low-salt, low-protein diet is often recommended because it may lower the amount of waste your kidneys have to filter.^1,9,12

Here are other lifestyle changes you can make to help maintain kidney function:⁹

• Control your blood sugar if you have diabetes
• Control your blood pressure
• Avoid certain medicines that can damage your kidneys
• Take steps to monitor your kidneys
• Take medicines as prescribed by your doctor
• Maintain a healthy weight
• Exercise regularly
• Stay hydrated
• Do not smoke
• Get enough sleep

Treating end-stage kidney disease

If your kidneys are severely damaged and are no longer functioning, it is called end-stage kidney disease or kidney failure. If you have kidney failure, you will need one of the following treatments:¹³

• Hemodialysis
• Peritoneal dialysis
• Kidney transplant